SALEM SPEECH AND HEARING CLINIC

SALEM, OHIO 44460

(330) 831-1019

Name: Nolan S Diagnosis Codes:

DOB: Period Covered: 1/27/18 – 5/5/18
Age: Type of Sessions: Articulation/Pragmatics
Parents Number of Visits:
Address: Student Clinician: Emily Cavanaugh
City: Supervisor: Ann Smith, M.A. CCC-SLP
Phone:

Statement Of the Problem

Nolan, a 17 year old male, has been attending speech therapy services at the Salem Speech and
Hearing Clinic sing July of 2009. Nolan presents with the diagnosis of Childhood Apraxia of
Speech (CAS), and previous therapy has targeted articulation errors due to his CAS which
impact his intelligibility. Currently, therapy is targeting productions of vocalic /r/, specifically
“or” and “ar,” as well as the production of /z/, medial /l/, and the initiation and maintenance of
eye contact.

Background Information

As previously mentioned, Nolan was diagnosed with Childhood Apraxia of Speech and currently
receives services for speech through his school as part of his Individualized Education Plan
(IEP). Nolan is a motivated individual, and is receptive and hardworking throughout speech
therapy sessions. He consistently demonstrates comprehension of articulation placements and
pragmatic rules regarding eye contact, and is often observed self-monitoring these skills.

Test Results and Observations

Goals for the current semester were determined based on the clinician’s observations from the
initial session, as well as recommendations made by the previous clinician. During the initial
session, it was noted that Nolan demonstrated difficulties achieving the appropriate voicing
needed to produce /z/ in all word positions and contexts. Difficulties were also noted for the
production of vocalic /r/ in all word positions, and for /l/ in medial positions. He exhibited few
instances of initiated eye contact when answering questions and within conversation, and when
eye contact was made it was rarely sustained. No formal testing was administered during this
Spring 2018 semester.

Objectives and Results

The following long and short term objectives were established for the semester:
 1) LTG 1: NS will accurately produce /z/ in all positions at word level in 80% of
opportunities within a structured activity with minimal support.
STG 1a: NS will produce /z/ with adequate voicing in isolation in 75% of
opportunities within a structured activities with moderate support.
STG 1b: NS will produce /z/ with adequate voicing at syllable level in 75% of
opportunities within a structured activity with minimal support.
2) LTG 2: NS will accurately and independently produce medial /l/ at a conversational
level in 85% of opportunities.
STG 2a. NS will accurately produce medial /l/ at sentence level in 80% of
opportunities within a structured activity with minimal support.
STG 2b. NS will accurately and independently produce medial /l/ at sentence
level in 90% of opportunities.
3) LTG 3. NS will accurately and independently produce vocalic /r/ at a conversational
level in 80% of opportunities.
STG 3a. NS will accurately produce vocalic /r/ at sentence level in 85% of
opportunities within a structured activity with minimal support.
STG 3b. NS will accurately produce vocalic /r/ at a conversational level in 80% of
opportunities with minimal support.
4) LTG 4. NS will engage in eye contact with the clinician in order to initiate and
maintain conversation in 75% of opportunities provided throughout the session with
minimal visual supports.

Progress was made across most objectives throughout the semester, with performance remaining
consistent specifically through the second half of the semester. Progress is depicted in the
following chart by providing baseline and final data for each objective. Final data is determined
by an average taken from the last two sessions.

Objectives: Results: Met/Not Met:

1) NS will accurately Baseline: 1/27/18 Goal 1a: In Progress
produce /z/ in all 0/11 (0%) with maximal Goal 1b: In Progress
positions at word level support
in 80% of Goal 1: N/A
opportunities within a
structured activity
with minimal support. Final: 3/24/18 – 4/14/18
a) NS will produce /z/ 19/44 (43%) with maximal
with adequate voicing support
in isolation in 75% of
opportunities within a
structured activity
with moderate
support.
b) NS will produce /z/
with adequate voicing
at syllable level in
75% of opportunities
 within a structured
activity with minimal
support.

2) NS will accurately Baseline: 1/27/18 Goal 2a: In progress

and independently 5/8 (62%) with maximal
produce medial /l/ at support Goal 2: N/A
conversational level in
85% of opportunities.
a) NS will accurately Final: 3/24/18 – 4/14/18
produce medial /l/ at 26/34 (76%) with minimal
sentence level in 80% support
of opportunities
within a structured
activity with minimal
support.

3) NS will accurately Baseline: 1/27/18 Goal 3a: In Progress

and independently “ar” 5/6 (83%)
produce vocalic /r/ at “or” 4/6 (67%) with maximal Goal 3: N/A
conversational level in support
80% of opportunities.
a) NS will accurately Final: 3/24/18 – 4/14/18
produce vocalic /r/ at “ar” 22/31 (71%)
sentence level in 85% “or” 19/26 (62%) with
of opportunities minimal support
within a structured
activity with minimal
support.

4) NS will engage in eye Baseline: 1/27/18 Goal 4: Met

contact with the 7/22 (32%) with moderate
clinician in order to support
initiate and maintain
conversation in 75% Final: 3/24/18 – 4/14/18
of opportunities 33/41 (80%) with minimal
provided throughout support
the session with
minimal visual
supports.

Procedures
The following procedures were used throughout the semester:

- Positive reinforcement was provided at a variable ratio throughout the session with verbal
praise.
- Direct verbal models were provided for targeted speech sounds.
- Use of verbal and visual placement cues for targeted speech sounds.
- Use of tactile cues for targeted speech sounds.
- Use of visual supports to reinforce carrier phrases and facilitating contexts.
- Use of “vocal warm ups” with voiced sounds to facilitate voicing for the production of
/z/.
- Use of a visual cue to prompt for initiation of eye contact.
- Use of withholding to facilitate sustained eye contact.
- Use of a kazoo in order to facilitate voicing for the production of /z/.
- Pre-teaching of placements and appropriate rate provided before articulation activities.

Summary and Recommendations

Overall, Nolan has demonstrated progress across all articulation and pragmatic goals. He was
able to achieve voicing when provided with carrier phrases within facilitating contexts, and was
motivated throughout all drill activities even though they were perceived as difficult. Increased
intelligibility was also noted in the production of medial /l/ and vocalic /r/ sentences, with
accurate productions drastically increasing with cues to use a slower rate when speaking. Nolan
made significant progress in the use of initiating and sustaining eye contact, demonstrating the
skill independently within sessions and using self-monitoring. His ability to maintain
conversations with the clinician has improved with the use of this skills, and he has required
reduced supports throughout the semester. It is recommended that he continue to receive speech
therapy services at the Salem Clinic targeting the production of /z/, /l/, and /r/, as well as
continued monitoring for the use of eye contact. Based on performance thus far, motivation, and
attendance, Nolan’s prognosis for continued progress is good.

________________________ _____________________________
Emily Cavanaugh Ann Smith, M.A. CCC-SLP
Graduate Student Clinician Clinic Instructor

____________________________
Cindy Peshel, M.A. CCC-SLP
Clinical Instructor